DoD report calls for changes at Fort Benning to address heat injuries

As home to the U.S. Army Infantry School and the Maneuver Center of Excellence, Fort Benning, Georgia is the site of lots of long ruck marches and runs in the brutal summer heat. It’s not the hottest military base – that honor goes to Marine Corps Air Station Yuma, Arizona – but it sees average high temperatures of 90 degrees or more from June through July. Between exertion levels and the swelter factor, Fort Benning has the highest incidence rate of heat injuries across the Defense Department.

Cases of heat exhaustion at Fort Benning are rising steadily, a new five-year report published by the Defense Health Agency shows. The report goes on to suggest that Benning leaders take steps to mitigate heat injuries, including having medical personnel on hand for marches and runs over four miles long. Post officials, though, say they’re still evaluating the next steps.

cooling tank Fort Benning heat injuries — A trainee with 2nd Battalion, 60th Infantry Regiment puts his arms in an arm immersion cooling tank during training. The tanks allow Soldiers to rapidly cool by putting their forearms into a tank of ice water. (Photo by Saskia Gabriel)

The new heat injury data was published in the April issue of the Defense Department’s Medical Surveillance Monthly Report, or MSMR. The report analyzed heat injury data from 2017 to 2021, finding a total of 1,911 reported heat casualties during that period.

“Most patients were junior enlisted and officer personnel who were engaged in initial entry training,” study authors Lt. Col. David DeGroot, Kaemmer Henderson and Col. Francis O’Connor (ret.) wrote.

Heat exhaustion cases are on the rise

Heat exhaustion cases were the largest category of heat-related illnesses for each of the five years studied. Heat exhaustion is one of the milder diagnoses, and occurs when the body can’t cool itself down quickly enough through sweating. Symptoms can include confusion, dizziness, fainting, cramping, and rapid heartbeat. If left untreated, it can lead to the more severe condition of heatstroke.

heat injuries drill Fort Benning — Benjamin Haigh, a paramedic with Emergency Medical Services, loads a notional casualty into the back of an ambulance at the conclusion of a heat casualty drill April 28 at the Noncommissioned Officer Academy on post.

In 2017, Benning reported 130 cases of heat exhaustion; in 2018, 159; in 2019, 185; in 2020, 248; and in 2021, 285. Last year, heat exhaustion accounted for nearly 78% of all the reported heat illnesses, according to the MSMR analysis.

Other heat illness categories have stayed relatively stable or somewhat decreased. Heat stroke incidents nearly doubled from 55 in 2017 to 95 in 2018, rising to a peak of 96 in 2019 before dropping down to an average of 51 over the next two years. Cases of hyponatremia, when sodium levels fall dangerously low, usually because of drinking too much water in hot weather, have fluctuated. In 2017, 13 cases were reported; in 2019, just two. Last year there were six cases. Nonspecific heat injuries are on the way down, from 192 in 2019 to an average of 25 over the last two years.

The rise in heat exhaustion cases could be due to a number of reasons: It’s possible that Benning staff are getting better at catching heat illness cases before they escalate into more serious conditions. In 2019, in response to the problem of heat casualties during training, some of them fatal, Benning stood up The Army Heat Center on post to study the problem and work on prevention.

Fort Sill heat mitigation water tank — A Soldier assigned to Delta Battery, 1st Battalion, 31st Field Artillery Regiment, 434th Field Artillery Brigade, Fort Sill, OK, submerges his sleeves in a barrel of water to help mitigate the risk of becoming a heat casualty May 6, 2020, on Fort Sill. Soldiers of Delta Battery are being evaluated on their ability to complete a foot march then with minimal delay, conduct several exercises and qualify on their assigned weapon during Basic Combat Training. (U.S. Army photo by Sgt. Dustin D. Biven / 75th Field Artillery Brigade)

“The two-fold increase in heat exhaustion casualties during the surveillance period may be the result of improved recognition, overdiagnosis, and/or improved … coding rather than a true increase in the number of heat exhaustion casualties,” the report’s authors wrote. “The dramatic increase in heat injury casualties in 2019 and subsequent drop in 2020 reinforce this point. Conversely, the increase in heat exhaustion may also be attributed to fewer casualties progressing in severity to heat stroke due to improvements described in this report.”

Since all drill sergeants started getting heat illness recognition training in 2020, as part of their in-processing, and were advised to err on the side of caution, it’s also possible that milder heat illnesses are now over-diagnosed, the authors said.

COVID-19 precautions may also have played a role in rising heat exhaustion cases, the authors suggested. Trainees at Benning had to comply with Defense Department-wide mandates to wear a face mask at most times during the height of the pandemic. But, the authors added, that this factor is tough to pin down.

“While the wearing of a surgical mask has minimal impact on thermoregulatory responses to mild exercise in the heat, thermal sensation (one’s perception of how hot or cold they feel) can be negatively affected,” they wrote. “Given the widespread wearing of face coverings during the pandemic and the subjective nature of heat exhaustion symptoms, such as generalized weakness, headache, fatigue, and lightheadedness, it may be difficult, if not impossible to quantify the impact of face coverings on the observed frequency of heat illnesses.”

Heat strokes are strongly linked to specific training

U.S. Army Airborne School students carry their primary and reserve parachutes back to the pack shed April 28, 2020 at Lawson Army Airfield on post. (U.S. Army photo by Patrick A. Albright, Maneuver Center of Excellence and Fort Benning Public Affairs)

In any case, the report stated, cases of heat stroke, which remain high, present the greatest concern. Heat stroke accounted for 250 days of hospitalization across the five-year period, more than all the other heat illnesses combined; it also led to one fatality.

There have been at least nine deaths attributed to heat stroke or hyponatremia at Fort Benning since 1998, according to MSMR reports. Heat-related fatalities at the post occur every two to three years on average.

Heat stroke incidents are very heavily correlated with two specific training activities: marches with combat load, and runs over four miles.

“Given the potential fatal nature of heat stroke and the requirement for rapid, aggressive cooling, the lack of medical coverage during run and foot march events is concerning,” the authors wrote.

The data, they said, suggested that Fort Benning should change its policy and categorize these march and run events as “high risk,” which would then require an Army combat medic to be on-site. Only medical personnel can take Soldiers’ core and rectal temperature readings, they added, so medics are best positioned to perform the rapid cooling through cold water immersion that represents the most effective treatment for heat casualties.

Fort Benning is already looking into changes, according to the authors: During the 2022 Fort Benning Heat Forum, held in February, post leaders discussed medical support for hikes and runs. Since the forum, the Fort Benning garrison safety office has kicked off a review of what training events are considered high-risk, the report said.

Heat injuries Fort Benning David DeGroot talk — Lt. Col. David DeGroot, Army Heat Center director, Fort Benning, Georgia, briefs Soldiers on the importance of recognizing heat injuries and illnesses at Fort Rucker, Alabama, April 25, 2022. “There’s a lot of risk factors, and we tend to overemphasize the role of hydration,” said DeGroot, “By making sure that a Soldier or yourself is normally hydrating is not the magic bullet that fixes the heat problem, because of all of these other risk factors.”

But for now, no changes have been made. In statements provided to Sandboxx News, DeGroot, director of the Heat Center as well as an author of the MSMR study, said commanders are currently responsible for assessing risk in training events.

“Using a ruck march conducted during summer months as an example, a commander may prepare ice water dunk tanks, ice sheets, or adjust start times to take advantage of lower ambient temperatures,” DeGroot told Sandboxx News. “Overall I remain optimistic that the prevention, education, training, and surveillance efforts continue to have a positive impact on heat safety.”

He added that Benning remained in an “active posture” to address safety concerns and was constantly assessing trends and looking for areas for improvement.

“Timed foot march and run events are not inherently high-risk,” he said. “However, the combination of risk added by heat, humidity, and rigorous Infantry and Armor training can only be mitigated through policies and procedures established by the safety team and commanders.”